Background Marlex mesh erosions may occur as late complications after vertical-banded gastroplasty. Experience with the endoscopic treatment is limited. Objective To describe the use of argon plasma ...coagulation in the endoscopic treatment of eroded Marlex mesh. Design Case report. Settings Endoscopy Unit, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA. Patients We describe the endoscopic treatment of eroded Marlex mesh in 2 patients who presented with symptoms of gastric-outlet obstruction. Interventions In both cases, argon plasma coagulation was used to break down the eroded Marlex mesh. Fragments were subsequently removed with forceps and electrocautery snares. We did not encounter any complications with this method. Results The endoscopic treatment resulted in lasting symptomatic improvement in both patients. Limitations Our experience is limited to 2 cases. Conclusions Argon plasma coagulation appears to be a promising option for the endoscopic treatment of eroded Marlex mesh. It allows the fragmentation of large mesh portions and enables subsequent removal with a snare and a forceps. This method can result in symptomatic improvement and may obviate the need for surgery. Further data are necessary to evaluate the safety and the efficacy of this approach.
Diabetes self-management refers to all activities patients undertake to care for their illness, promote health and prevent the long- and short-term effects of diabetes. This study compared the ...effectiveness of 2 diabetes self-management education methods by examining changes in glycated hemoglobin (A1C) levels and knowledge, attitudes and behaviours (KABs) after traditional group education (TE) or with diabetes conversation maps (CMs). The CMs group was postulated to show greater decrease in A1C levels and improved KABs scores compared to the TE group.
A sample of 21 eligible clients from Diabetes Care Guelph were randomly assigned into 2 groups: 10 receiving education through CMs and 11 through TE. Changes in knowledge and attitude were determined by using questionnaires and repeated-measures pretest and post-test design before and after the education sessions. Changes in A1C levels were determined by comparing values at baseline and at 3 months after receiving diabetes education. Two focus groups were conducted to obtain participants' perceptions of the education methods and self-reported KAB changes.
Significant differences in knowledge and attitude score changes were observed from baseline/initial education and after 3 months. Both groups had significant decreases in A1C levels from baseline to 3 months afterward. Focus groups revealed themes common to both groups, such as benefits of early education, the need for multiple lifestyle behaviour changes and feelings about social support.
CMs had a significant impact and are effective for group education. The changes observed may lead to improved diabetes self-management, thus reducing costly health complications related to poorly controlled diabetes.
La prise en charge autonome du diabète concerne toutes les actions que les patients entreprennent pour prendre soin de leur maladie, préserver la santé et prévenir les conséquences du diabète à court et à long terme. C'est par l'étude des changements dans les concentrations de l'hémoglobine glyquée (A1c) et dans les connaissances, les attitudes et les comportements (CAC) après l'éducation traditionnelle en groupe (ÉT) ou à l'aide des outils Conversation MapMC d'éducation au diabète (CM) que nous avons pu comparer l'efficacité des 2 méthodes d'éducation à la prise en charge autonome du diabète. Nous avons présumé que le groupe CM montrait une plus grande diminution des concentrations de l'A1c et une amélioration des scores CAC par rapport au groupe ÉT.
Nous avons réparti de manière aléatoire en 2 groupes un échantillon de 21 clients admissibles de la clinique Diabetes Care Guelph, soit 10 qui bénéficiaient des CM et 11 qui recevaient une ÉT. Nous avons déterminé les changements dans les connaissances et les attitudes au moyen de questionnaires et de plans expérimentaux prétest et post-test à mesures répétées avant et après les séances d'éducation. Nous avons déterminé les changements dans les concentrations de l'A1c en comparant les valeurs du début et les valeurs 3 mois après avoir reçu une éducation au diabète. Nous avons mené 2 groupes de discussion pour obtenir les perceptions des participants à l'égard des méthodes d'éducation et des changements auto-rapportés dans les CAC.
Nous avons observé des différences importantes de changements dans les scores sur les connaissances et les attitudes entre le début de l'éducation et après 3 mois. Les deux groupes ont montré des diminutions importantes dans les concentrations de l'A1c entre le début et 3 mois plus tard. Les groupes de discussion ont mis en évidence des points communs aux deux groupes tels que les avantages de l'éducation précoce, la nécessité de changer de nombreux comportements liés au mode de vie et les impressions sur l'accompagnement social.
Les CM ont eu des répercussions importantes et se sont révélés efficaces pour l'éducation en groupe. Les changements observés peuvent entraîner l'amélioration de la prise en charge autonome du diabète, par conséquent la réduction des coûts des complications de santé liées à la mauvaise régulation du diabète.
•Use of healthy conversation skills support patient reflection and behaviour change.•There are challenges in translating new skills into practice.•Time to reflect on and review practice may help ...practitioners embed new skills.•Women appreciate interactions with practitioners trained in HCS.
In a pilot RCT we assessed training a dietitian in “Healthy Conversation Skills” (HCS) to support behavior change. This study describes the acceptability of the intervention from the participant and practitioner perspective.
Seventy pregnant women participated (intervention = 33; control = 37). The evaluation included: i)audio-recording sessions to assess use of HCS from the intervention dietitian; ii)semi-structured interview with the intervention dietitian to assess experiences of using HCS; iii)Quality of Prenatal Care Questionnaire and focus groups to assess participants’ views of study experience.
Intervention sessions involved conversations where the dietitian used HCS. The dietitian reflected on the simplicity of learning HCS in training but the challenges of embedding these new skills in practice and highlighted the need to review and reflect on practice as an ongoing process. Intervention participants were more satisfied with the study (p = 0.05) and more likely to agree that the dietitian took time to ask about things that were important to them (p = 0.04) than control participants.
Use of HCS by practitioners is an acceptable way to support lifestyle changes in pregnancy.
Use of HCS provide opportunities to support behaviour change. Review of and reflecting on practice may facilitate the application of new skills in practice.
As surgical education programs develop surgical skills laboratories, it will be important to do so in the most efficient, cost-effective manner.
We distributed a brief written survey to all general ...surgery residents at the University of Iowa Hospitals and Clinics regarding their perceptions of the usefulness of a surgical skills laboratory in training of both open and laparoscopic techniques. For the initial survey, we used analysis of variance to compare differences across groups. This was followed by a second survey to post-graduate year (PGY)-1 and PGY-2 residents assessing their knowledge, perceived skill, and rank preference of surgical skill sessions.
We received 100% responses rate from both surveys. Respondents to the first survey represented all levels of residency (PGY1-PGY5), and the number of respondents per level ranged from 4 to six. Although there was general agreement that surgical skills laboratories were beneficial for both open and laparoscopic procedures and for all levels of training, there was more support for using them to prepare junior residents. In addition, they were seen as especially beneficial for teaching about laparoscopic techniques. Junior residents did not think that residents should be required to demonstrate mastery in the skills laboratory before being allowed to operate, whereas senior residents were neutral about such requirements. A follow-up survey targeted junior level residents (PGY-1 and 2) to assess their perceived skill for various techniques, and their interest in improving skills through simulation. Results showed that perceived skill differed between the two groups, as did attitudes about the priority for different skills.
As residency programs implement surgical skills laboratories, understanding local opinions about the potential benefits and sequencing may help to design the laboratories for maximal educational benefit.
Abstract only
Introduction
Gaining weight in excess of the Institute of Medicine gestational weight gain (GWG) guidelines is associated with adverse health outcomes for mother and child. It is ...estimated that 49% of women in Alberta gain excess gestational weight. Weight gain in pregnancy is multifactorial and there is a need to better support women during pregnancy to gain weight within the guidelines. A study in Edmonton, AB, aimed to understand if differing amounts of lifestyle support provided by a Registered Dietitian (RD) throughout pregnancy could help women achieve appropriate GWG. The purpose of these analyses is to understand if there was any difference in GWG between the three groups and to explore the gestational weight related perspectives of the women within the study.
Methods
Seventy low‐risk pregnant women, <20 weeks gestation, were randomized to an active control (AC) or intervention (INT) group where they saw a RD for two visits in pregnancy. The two visits occurred at < 24 weeks and 30 weeks gestation. Women completed lifestyle questionnaires throughout pregnancy and a postpartum questionnaire that asked about their prenatal experiences. A passive control group (PC) of women ≤12 months postpartum (n=55) was recruited to only complete the postpartum questionnaire. This group models standard prenatal care in Alberta (no RD visits in pregnancy). GWG information was collected from obstetrical charts and adherence to GWG recommendations was defined in accordance with IOM guidelines. Data were analyzed using chi‐square, t‐test, or one‐way ANOVA.
Results
Pre‐pregnancy BMI, ethnicity, education, marital status, household income and parity did not differ between INT (n=33), AC (n=37), and PC (n=55) groups. However, maternal age was different between the groups with the mean age in the PC group as 32.1 compared to 34.4 years for both the INT and AC groups (p=0.022). When asked about GWG perspectives, 78% (n=81) of women stated the amount of weight they gained was important to them with the top 3 reasons being: “To have a healthy pregnancy”, “To deliver a healthy baby” and “For my health”. Intentional changes were made by 68% of the women to help manage their weight in pregnancy, with ~45% changing the type of foods they ate (n=57) and 28% increasing their physical activity (n=35). Total GWG, rate of weight gain and adherence to GWG guidelines did not differ between the three groups. Overall, 50%, 42% and 8% of the participants exceeded, met and fell below the guidelines, respectively. Guideline concordance differed by pre‐pregnancy BMI category (p=0.024), with 78% of the overweight and 67% of the obese women exceeding the guidelines compared with 34% of women within a normal BMI. Women who agreed to feeling in control of their weight prior to pregnancy were more likely to gain weight within the guidelines during pregnancy (p=0.008).
Conclusion
Most women understand why weight gain in pregnancy is important, yet half exceed the guidelines. Understanding a woman's sense of weight control prior to pregnancy may help aid healthcare providers understand which women who may be at increased risk for excess GWG.
Support or Funding Information
The Danone Institute of Canada, Alberta Innovates Health Solutions
In this work, we report a study of the electrodeposition of SnSe. Considering the difficulty to stabilize the baths containing Sn(II) and Se(IV) precursors, we investigated the benefits of using ...sodium oxalate as a complexing agent. Preliminary cyclic voltammetric (CVs) experiments were performed to study the electrochemical behavior of tin and selenium redox systems within this specific electrolyte solution. The study revealed that the oxalate reagent stabilizes the bath chelating Sn(II) and then preventing the precipitation of SnO2. From the CVs, a growth mechanism is proposed and a synthesis potential window is defined, in which the electrodeposition of SnSe films was investigated. Between −0.5 and −0.6 V vs sat. AgCl/Ag, the deposits exhibit typical polycrystalline SnSe needle-like grains. SnSe was shown by Raman spectroscopy and the XRD patterns display an orthorhombic single-phase for this compound. Additional Mössbauer analyses confirm the presence of Sn(II), which is in good agreement with the chemical composition of SnSe films. Moreover, a cross-analysis between the methods shows also the presence of SnSe2 in minor proportion. The depth profile analyses of the samples reveal an in-depth homogeneity as well as the presence of oxygen at the layer surface.
Expression vectors used in different biotechnology applications are designed with domain-specific rules. For instance, promoters, origins of replication or homologous recombination sites are ...host-specific. Similarly, chromosomal integration or viral delivery of an expression cassette imposes specific structural constraints. As de novo gene synthesis and synthetic biology methods permeate many biotechnology specialties, the design of application-specific expression vectors becomes the new norm. In this context, it is desirable to formalize vector design strategies applicable in different domains.
Using the design of constructs to express genes in the chloroplast of Chlamydomonas reinhardtii as an example, we show that a vector design strategy can be formalized as a domain-specific language. We have developed a graphical editor of context-free grammars usable by biologists without prior exposure to language theory. This environment makes it possible for biologists to iteratively improve their design strategies throughout the course of a project. It is also possible to ensure that vectors designed with early iterations of the language are consistent with the latest iteration of the language.
The context-free grammar editor is part of the GenoCAD application. A public instance of GenoCAD is available at http://www.genocad.org. GenoCAD source code is available from SourceForge and licensed under the Apache v2.0 open source license.
In response to rising pharmacy costs in the Iowa Department of Corrections prison system, a retrospective analysis of psychiatric drug use and expenditures was performed for fiscal years 1990 through ...2000. Population-adjusted changes in use and expenditures over time were analyzed in aggregate and by drug class. Expenditures for psychiatric drugs increased 28-fold from $7,974 in 1990 to $381,893 in 2000, or from $291 to $8,138 per 100 inmates, while use increased fivefold. The use of antipsychotics remained relatively constant, but expenditures increased ninefold. In contrast, both use of and expenditures for antidepressants increased tremendously, from $215 to $1,929 per 100 inmates.
In 2001 the Second Edition of the American Psychiatric Association's Task Force Report on ECT maintained that no absolute contraindications to ECT exist. They warned, however, that ECT in persons ...with elevated intracranial pressure should be considered on a case-by-case risk to benefit ratio. Literature on the use of ECT in patients with elevated intracranial pressures is limited to space-occupying lesions as a cause for elevated pressures. This case report presents a 42-year-old woman with treatment-refractory major depression and idiopathic intracranial hypertension (also known as pseudotumor cerebri). Brain imaging and lumbar puncture were performed before ECT, and blood pressures were monitored closely during treatment. Treatment was successful with minimal adverse effects. With appropriate clinical observation, patients with idiopathic intracranial hypertension can be considered for ECT.
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